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Technetium Tc-99m Labeled Autologous White Blood Cells

Montana rates for HCPCS A9569

Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

Rates data updated July 2026.

How much does Technetium Tc-99m Labeled Autologous White Blood Cells cost?

$1,698

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $1,698 for this service. The price depends on where it is billed: about $1,698 from a physician practice, and about $3,090 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1,698$1,698 to $3,090
FacilityA hospital or hospital-owned outpatient department$3,090$2,692 to $3,090

How much rates vary

Facilitymedian $3,090 · 10th to 90th $51 to $3,981Professionalmedian $1,698 · 10th to 90th $51 to $3,090
$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0Kfacility $3,090professional $1,698

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,659.59
Median
$1,698.24
Typical High
$1,698.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$3,981.07
Typical High
$10,232.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$2,818.38
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$3,090.30
Typical High
$3,090.30
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$3,090.30
Typical High
$3,090.30
Providence
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,818.38
Typical High
$10,232.93
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,698.24
Typical High
$3,715.35
United
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$1,698.24

Where Montana sits

The same service costs 2.4 times more in Alaska than in Minnesota. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Montana $1,698 · 33rd of 51
AK $2,754MN $1,148

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.